Provider Demographics
NPI:1477797710
Name:DESERT VALLEY GASTROENTEROLOGY, LLC
Entity Type:Organization
Organization Name:DESERT VALLEY GASTROENTEROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-306-6405
Mailing Address - Street 1:3921 E BASELINE RD
Mailing Address - Street 2:SUITE 001
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2727
Mailing Address - Country:US
Mailing Address - Phone:480-306-6405
Mailing Address - Fax:480-306-6409
Practice Address - Street 1:3921 E BASELINE RD
Practice Address - Street 2:SUITE 001
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2727
Practice Address - Country:US
Practice Address - Phone:480-306-6405
Practice Address - Fax:480-306-6409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36236207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherTAX ID